Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: A randomized controlled trial.

Abstract

Traumatic stress due to conflict and war causes major mental health problems in many resource-poor countries. The objective of this study was to examine whether trained lay counselors can carry out effective treatment of posttraumatic stress disorder (PTSD) in a refugee settlement. In a randomized controlled dissemination trial in Uganda with 277 Rwandan and Somalian refugees who were diagnosed with PTSD the authors investigated the effectiveness of psychotherapy administered by lay counselors. Strictly manualized narrative exposure therapy (NET) was compared with more flexible trauma counseling (TC) and a no-treatment monitoring group (MG). Fewer participants (4%) dropped out of NET treatment than TC (21%). Both active treatment groups were statistically and clinically superior to MG on PTSD symptoms and physical health but did not differ from each other. At follow-up, a PTSD diagnosis could not be established anymore in 70% of NET and 65% TC participants, whereas only 37% in MG did not meet PTSD criteria anymore. Short-term psychotherapy carried out by lay counselors with limited training can be effective to treat war-related PTSD in a refugee settlement.

Identifying Priorities for Mental Health Interventions in War-Affected Youth: A Longitudinal Study

“…Although the treatment of complex trauma and related conditions, such as posttraumatic stress disorder, often requires highly trained mental health professionals (eg, psychiatrists and/or doctorallevel psychologists) and, often, an individual therapy setting, there is a growing evidence base suggesting that internalizing disorders can be treated by bachelor's-level mental health workers with rigorous training and supervision using evidenced-based techniques such as cognitive behavioral therapy and/or interpersonal therapy with minimal risk of adverse iatrogenic effects. 3,[18][19][20][21][22][23][24][25] Furthermore, a stepped care approach can be adopted in which the most acute individuals or those suffering from resistant trauma symptoms can be directed toward more sophisticated treatment resources tailored to their conditions if initial stabilization-focused interventions do not yield sufficient symptom relief. 26,27 A focus on war trauma has dominated many of the interventions for war-affected youth.…”

Narrative Expositionstherapie (NET) für Menschen nach Gewalt und Flucht

“…Deutliche Linderungen des seelischen Leidens ergeben sich in den ersten Monaten nach der Behandlung und gewinnen weiter bis zum Einjahresnachuntersuchungszeitpunkt, was auf eine positive Veränderung der Gesundheit, Funktionalität und Lebensqualität der Patienten schließen lässt. Sie bilden sich auch in der Erholung körper-licher Beeinträchtigungen ab (Morath et al 2014 (Neuner et al, 2008;Ertl et al 2011;Jacob et al 2014;Köbach et al 2015). Die NET kann also von entsprechend geschulten Traumaberatern als Modul angeboten werden und wäre damit innerhalb einer gesundheitlichen Gesamtversorgung von Geflüchteten in Deutschland denkbar (Elbert et al 2016).…”

Towards a contextually appropriate framework to guide counseling of torture survivors in Sub-Saharan Africa

“…Igreja, Kleijn, Schreuder, van Dijk, and Verschuur (2004) demonstrated the positive impact of a single session testimony approach with rural survivors of the Mozambican civil war. Studies have examined the efficacy of NET for the treatment of PTSD in various populations in Uganda (Neuner et al, 2008), Rwanda (Schaal, Elbert and Neuner, 2009) and South Africa (Hinsberger et al, 2017) with encouraging results. In the Democratic Republic of Congo (DRC), cognitive processing therapy was shown to reduce the incidence of depression, anxiety and PTSD symptoms among female survivors of sexual violence (Bass et al 2013).…”